Home Health Care Services Satisfaction Questionnaire

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
HHCS Satisfaction Survey_010318.doc Other-Questionnaire
Generic Clearance Submission_ HHCS.doc Generic Request_HHCS IC Document

Information Collection (IC) Details

IC Title:	Home Health Care Services Satisfaction Questionnaire	Agency IC Tracking Number:	2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire			HHCS Satisfaction Survey_010318.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request_HHCS	Generic Clearance Submission_ HHCS.doc	01/29/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.